Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study

Susanne P Martin-Herz; Phelgona Otieno; Grace M Laanoi; Vincent Moshi; Geofrey Olieng'o Okoth; Nicole Santos; Dilys Walker

doi:10.1136/bmjopen-2022-064678

Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study

BMJ Open. 2023 Aug 31;13(8):e064678. doi: 10.1136/bmjopen-2022-064678.

Authors

Susanne P Martin-Herz^#¹, Phelgona Otieno^#², Grace M Laanoi^{3

4}, Vincent Moshi², Geofrey Olieng'o Okoth², Nicole Santos⁵, Dilys Walker^{5

6}

Affiliations

¹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA Susanne.MartinHerz@ucsf.edu.
² Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
³ Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya.
⁴ Paediatric & Child Health, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya.
⁵ Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
⁶ Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.

^# Contributed equally.

Abstract

Objective: Data on long-term outcomes of preterm (PT) and low birth weight (LBW) infants in countries with high rates of neonatal mortality and childhood stunting are limited, especially from community settings. The current study sought to explore growth and neurodevelopmental outcomes of PT/LBW infants from a rural community-based setting of Kenya up to 18 months adjusted age.

Design: Cross-sectional study.

Setting: Migori County, Kenya.

Participants: Three hundred and eighty-two PT/LBW infants (50.2% of those identified as eligible) from a cluster randomised control trial evaluating a package of facility-based intrapartum quality of care interventions for newborn survival consented for follow-up.

Outcome measures: Caregiver interviews and infant health, growth and neurodevelopmental assessments were completed at 6, 12 or 18 months±2 weeks. Data included sociodemographic information, medical history, growth measurements and neurodevelopmental assessment using the Ten Questions Questionnaire, Malawi Developmental Assessment Tool and Hammersmith Infant Neurological Examination. Analyses were descriptive and univariate regression models. No alterations were made to planned data collection.

Results: The final sample included 362 PT/LBW infants, of which 56.6% were moderate to late PT infants and 64.4% were LBW. Fewer than 2% of parents identified their child as currently malnourished, but direct measurement revealed higher proportions of stunting and underweight than in national demographic and health survey reports. Overall, 22.7% of caregivers expressed concern about their child's neurodevelopmental status. Neurodevelopmental delays were identified in 8.6% of infants based on one or more standardised tools, and 1.9% showed neurological findings indicative of cerebral palsy.

Conclusions: Malnutrition and neurodevelopmental delays are common among PT/LBW infants in this setting. Close monitoring and access to early intervention programmes are needed to help these vulnerable infants thrive.

Trial registration number: NCT03112018.

Keywords: Community child health; Developmental neurology & neurodisability; NEONATOLOGY.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Child
Cross-Sectional Studies
Growth Disorders / epidemiology
Humans
Infant
Infant Mortality
Infant, Low Birth Weight
Infant, Newborn
Kenya / epidemiology
Malnutrition*
Rural Population*

Associated data

ClinicalTrials.gov/NCT03112018